It is only relatively recently that science and technology have managed to gain reproducible control over large swathes of our lives.Much of evolution has taken place in an environment in which relationships were much more important than facts.But we who are living have experienced a world in which science and technology develop so rapidly we can be sucked into the illusion that everything will soon be described, understood and so come under our control.
We acquire not only to a touching faith in the power of rationality, but a corresponding disregard for those aspects of being human which are nonrational.
Clinical practice reflects this general social trend: patients can easily become seen as faulty machines in need of an MOT, a regular service, and a quick pit-stop when a wheel falls off.
The Human Effect in Medicine is about the other side of the interaction between practitioner and patient.People have needs that are non-rational and seek responses that deal with other parts of the psyche, which may explain much of the popularity of complementary therapies.
The book contains an interesting review of the philosophy and history ofmedical practice.The way we do things now is not self-evidently the only, or best, way to practise.Through an historical analysis, it explores the weaknesses in current care and treatment.
The book then considers the placebo.The word has taken on pejorative overtones, but the authors point out that if something works, then in a very real sense it isn't a placebo at all.
The apparent absurdity is easy to understand: placebos achieve effects by means which we do not understand and because we do not understand them we label them in ways which deny them: magic, placebo, miracle, delusion.
The book ends on the subject of turning theory into practice.
Its earlier intellectual approach finds a solid base for understanding how to make our relationships with patients better. It encourages us not to see magic and mystery as something dishonest, but as a way of helping people.
Empathy, reassurance, touch, laughter and other ways of relating get a mention. In the descriptions I can recall very good clinicians who had come to this understanding for themselves through experience.
The rest of us could do w ith a helping hand.
Dr Mark Charny Translucency consultancy (former director of the National Centre for Clinical Audit).